WSJ trend or no, it's deeply irresponsible fear-mongering. Teresi's argument against organ donation, insofar as there's any logic worthy of the term "argument", seems to revolve around three separate premises. The first is that, as an organ donor, you have no right to informed consent if you're brain dead. This is (marginally) true, although Teresi implies that physicians then swoop in on you, mad-scientist like, and perform unspeakable, ghoulish acts on your body. We'll get to that in a few paragraphs.

The second premise is that, if declared brain dead, you may not in fact be dead. As such, Teresi wins an award for being allowed to express his inner six year-old in the eminent pages of WSJ.That's pretty much the substance of this "argument". The "not really dead" shtick is a fear that reached its zenith in Germany in the late 19th century, where the fear of premature burial was so profound that "waiting mortuaries" were built, though no recorded accidentally-classified living people ever rose in the manner of Lazarus. Republican lawmakers, most infamously Senate Majority leader Bill Frist, were eager to whip up such anxieties in the case of Terri Schiavo, and Teresi's scribblings are of a piece with that.

The third premise, which can only be described as "rich" as they come on the pages of the Wall Street Journal, is that organ transplantation is big business. "Average recipients are charged $750,000 per transplant," Teresi notes. He then reasons that maybe donors and their families can get a piece of that action: "It is possible that not being a donor on your license can give you more bargaining power. If you leave instructions with your next of kin, they can perhaps negotiate a better deal."

It's really quite amazing that WSJ allowed this bit of nonsense into its pages, for doctors and hospitals do not, under any circumstances, haggle with families over the lives of potential organ donors or "negotiate deals" with families. If there's a case of brain death where we might be able to harvest organs, and the patient in question does not have an organ donation status on their driver's license, members of an organ donation team, not the docs taking care of the patient, ask next of kin--once--if they would consider organ donation. If the answer is no, then it's no, and that's that.

Money is never discussed and certainly none ever changes hands. Teresi implies something sinister in the money involved in organ donation, which raises the question as to whether he is a fully functioning adult. What--does he think that medicine doesn't involve money? As to whether money affects organ donation the same way it does, say, the buying and selling of automobiles, it isn't the same at all. There aren't docs out there getting "finder's bonuses" for snatching the greatest number of bodies, though he barely stops short of implying this, and there aren't people out there trying to game the system, lurking the halls of hospitals, just waiting for the big payday when someone's EEG goes flat.

The actual process of harvesting organs from a body is, in its details, best left to be discussed among professionals or those with either the morbid curiosity or intestinal fortitude to sustain them. The same could be said of routine colectomies. In both cases the goal is to save the lives of the patients--and in organ transplantation, the medical teams often succeed mightily. In 2011, over 22,000 organs were harvested from ~6,000 patients declared brain dead: most of the organs donated were kidneys, livers, hearts and lungs. There are a lot of people alive today walking around because of those organs. I can't emphasize this enough: thousands of people wouldn't be alive were it not for organ donors and the process of organ donation. It's among the reasons why I'm in the biz (in medicine, that is: I have only passing involvement in transplants, mostly in infectious disease consultations on transplant patients). Two helpful fact sheets on organ donation can be found here and here.

Organ donation is one of the few true miracles of modern medicine. It is based on the clear calculation that one's body, when no longer of use to one's soul, might be able to benefit the souls of others by sustaining their bodies. If members of the Billy Rubin Blog staff went out to lunch (meaning: if I got into my car) and had an unfortunate mishap with an 18-wheeler, I would want to cry out, "TAKE EVERY DAMNED THING YOU WANT, FROM MY CORNEAS TO MY COLON!" Alas, I wouldn't be heard in such circumstances...which is why there's a little red heart at the bottom right corner of my driver's license. I highly recommend everyone else put that heart down there too, though Dick Teresi is welcome to have a special license that says in small type "I am a heartless, selfish bastard", which indeed he is.
--br

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About Me

I'm a physician and an educator with a clinical focus in infectious disease. I teach the spectrum from 3rd year medical students through senior ID fellows, and try to keep everyone loose when doing so. Whether I succeed or not, you'll have to ask them.
I am interested in issues where medicine intersects with politics, as well as how medical research is portrayed by media. In some ways my views are very much at the fringe of the rest of the physician community, although in several other critical ways I’m your typical stethoscope-wielding, white-coat-wearing, reflex-hammer-tapping doc and consider myself steeped in the traditions of the brotherhood and sisterhood.